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The authors would like to acknowledge the University of Gondar for its support and facilitation of the study. The authors also want to thank all the study participants for their collaboration and participation in the study. 1. Gebreyohannes EA, Bhagavathula AS, Gebresillassie BM, Tefera YG, Belachew SA, Erku DA. Recreational use of phosphodiesterase 5 inhibitors and its associated factors among undergraduate male students in an Ethiopian University: a cross-sectional study. World J Mens Health. (2016) 34:186–93. doi: 10.5534/wjmh.2016.34.3.186 2. Guay AT, Perez JB, Jacobson J, Newton RA. Efficacy and safety of sildenafil citrate for treatment of erectile dysfunction in a population with associated organic risk factors. J Androl. (2001) 22:793–7. Erratum in: J Androl. (2002) 23:113. doi: 10.1002/j.1939-4640.2001.tb02582.x 3. Harte CB, Meston CM. Recreational use of erectile dysfunction medications and its adverse effects on erectile function in young healthy men: the mediating role of confidence in erectile ability. J Sex Med. (2012) 9:1852–9. doi: 10.1111/j.1743-6109.2012.02755.x 4. Zusman RM, Morales A, Glasser DB, Osterloh IH. Overall cardiovascular profile of sildenafil citrate. Am J Cardiol. (1999) 83:35C−44C. doi: 10.1016/S0002-9149(99)00046-6 5. Delate T, Simmons VA, Motheral BR. Patterns of use of sildenafil among commercially insured adults in the United States: 1998-2002. Int J Impot Res. (2004) 16:313–8. doi: 10.1038/sj.ijir.3901191 6. Bechara A, Casabé A, De Bonis W, Helien A, Bertolino MV. Recreational use of phosphodiesterase type 5 inhibitors by healthy young men. J Sex Med. (2010) 7:3736–42. doi: 10.1111/j.1743-6109.2010.01965.x 7. Makwana S, Solanki M., Raloti S., Dikshit R. Evaluation of recreational use of aphrodisiac drugs and its consequences: an online questionnaire based study. Int J Res Med. (2013) 1:51–9. 8. Harte CB, Meston CM. Recreational use of erectile dysfunction medications in undergraduate men in the United States: characteristics and associated risk factors. Arch Sex Behav. (2011) 40:597–606. doi: 10.1007/s10508-010-9619-y 9. Schnetzler G, Banks I, Kirby M, Zou KH, Symonds T. Characteristics, behaviors, and attitudes of men bypassing the healthcare system when obtaining phosphodiesterase type 5 inhibitors. J Sex Med. (2010) 7:1237–46. doi: 10.1111/j.1743-6109.2009.01674.x 10. Gebregeorgise DT, Belay YM, Kälvemark Sporrong S. Sildenafil citrate use in Addis Ababa: characteristics of users and pharmacists' dispensing practices. Int J Clin Pharm. (2018) 40:67–73. doi: 10.1007/s11096-017-0558-8 11. Both R. Sex, tension, and pills: young people's use of contemporary reproductive and sexual health technologies in Addis Ababa, Ethiopia (Doctoral dissertation). Anthropology Department, University of Amsterdam, Amsterdam, Netherland (2017). Available online at: https://pure.uva.nl/ws/files/9794196/Thesis_complete_.pdf 12. Both R. A matter of sexual confidence: young men's non-prescription use of Viagra in Addis Ababa, Ethiopia. Cult Health Sex. (2016) 18:495–508. doi: 10.1080/13691058.2015.1101489 13. Cheitlin MD, Hutter AM Jr, Brindis RG, Ganz P, Kaul S, Russell RO Jr, et al. Use of sildenafil (Viagra) in patients with cardiovascular disease. Technology and Practice Executive Committee. Circulation. (1999) 99:168–77. doi: 10.1161/01.CIR.99.1.168 14. Santtila P, Sandnabba NK, Jern P, Varjonen M, Witting K, von der Pahlen B. Recreational use of erectile dysfunction medication may decrease confidence in ability to gain and hold erections in young males. Int J Impot Res. (2007) 19:591–6. doi: 10.1038/sj.ijir.3901584 15. Schiefer J, Sparing R. Transient global amnesia after intake of tadalafil, a PDE-5 inhibitor: a possible association? Int J Impot Res. (2005) 17:383–4. doi: 10.1038/sj.ijir.3901301 16. Pomara G, Morelli G, Menchini-Fabris F, Dinelli N, Campo G, LiGuori G, et al. Epistaxis after PDE-5 inhibitors misuse. Int J Impot Res. (2006) 18:213–4. doi: 10.1038/sj.ijir.3901383 17. Tiryakioglu SK, Tiryakioglu O, Turan T, Kumbay E. Aortic dissection due to sildenafil abuse. Interact Cardiovasc Thorac Surg. (2009) 9:141–3. doi: 10.1510/icvts.2009.205849 18. Nachtnebel A, Stöllberger C, Ehrlich M, Finsterer J. Aortic dissection after sildenafil-induced erection. South Med J. (2006) 99:1151–2. doi: 10.1097/01.smj.0000240732.65859.aa 19. Suleman S, Woliyi A, Woldemichael K, Tushune K, Duchateau L, Degroote A, et al. Pharmaceutical regulatory framework in ethiopia: a critical evaluation of its legal basis and implementation. Ethiop J Health Sci. (2016) 26:259–76. doi: 10.4314/ejhs.v26i3.9 20. Gebretekle GB, Serbessa MK. Exploration of over the counter sales of antibiotics in community pharmacies of Addis Ababa, Ethiopia: pharmacy professionals' perspective. Antimicrob Resist Infect Control. (2016) 5:2. doi: 10.1186/s13756-016-0101-z 21. Jackson G, Montorsi P, Cheitlin MD. Cardiovascular safety of sildenafil citrate (Viagra): an updated perspective. Urology. (2006) 68(3 Suppl):47–60. doi: 10.1016/j.urology.2006.05.047 22. Kloner RA, Jackson G, Emmick JT, Mitchell MI, Bedding A, Warner MR, et al. Interaction between the phosphodiesterase 5 inhibitor, tadalafil and 2 alpha-blockers, doxazosin and tamsulosin in healthy normotensive men. J Urol. (2004) 172(5 Pt 1):1935–40. doi: 10.1097/01.ju.0000142687.75577.e4 23. Ethiopia CC. Summary and Statistical Report of the 2007 Population and Housing Census. Addis Ababa: Federal Democratic Republic of Ethiopia population Census Commission (2008). 24. Ausó E, Gómez-Vicente V, Esquiva G. Visual side effects linked to sildenafil consumption: an update. Biomedicines. (2021) 9:291. doi: 10.3390/biomedicines9030291 25. Gebreslassie M, Feleke A, Melese T. Psychoactive substances use and associated factors among Axum University students, Axum Town, North Ethiopia. BMC Public Health. (2013) 13:693. doi: 10.1186/1471-2458-13-693 26. Lindsey WT, Stewart D, Childress D. Drug interactions between common illicit drugs and prescription therapies. Am J Drug Alcohol Abuse. (2012) 38:334–43. doi: 10.3109/00952990.2011.643997 27. Murtadha M, Raslan MA, Fahmy SF, Sabri NA. Changes in the pharmacokinetics and pharmacodynamics of sildenafil in cigarette and cannabis smokers. Pharmaceutics. (2021) 13:876. doi: 10.3390/pharmaceutics13060876

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Another way to increase the flexibility of your pelvis and restore sexual energy is by stretching your hip joints specifically. To do this, go into a plank and push your hips upwards and then downwards in an alternate motion. This will also strengthen your lower back and tone your thigh muscles. Your core is also made stronger when you maintain this position for some time. The arms and shoulders, moreover, are strengthened when they carry the weight of your upper body. Go into a plank position. Place your palms firmly on the floor in line with your shoulders. Extend your legs at the back. Keep your elbows and knees straight. Bring your body in one straight line from head to toe. Raise your hips so that your body is in the shape of a mountain. Lower your hips and bring it as close to the floor as possible without touching it. Repeat in a seamless motion. Bridge pose
This type of exercise has been shown to help reduce erectile dysfunction. One reason for this is because aerobic exercise lowers blood pressure. .

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Stability ball is one of the most versatile exercise equipment out there. You can use it to stretch and strengthen any part of your body. Vidyut, for instance, has incorporated it into his kalari sutra workout. He has placed his feet atop it while being in a plank position and pushed his hips upward and downward in an alternate motion, so as to stretch and strengthen the joints. When you do this exercise, make sure you maintain proper balance and stop your legs from falling off the stability ball. Go down on all fours. Place your palms on the floor in line with your shoulders. Lift your legs off the floor and place them on a stability ball. Keep your elbows and knees straight. Raise your hips to make a mountain with your body. Lower your hips and bring them as close to the floor as possible without touching it. Repeat in a seamless motion.
The patient considering prosthesis implantation, should be aware of the different types of prosthesis, risks of infection and erosion, mechanical failure and resulting re-operations, differences from the normal flaccid and erect penis including the possibility of penile shortening, and the potential reduction in the effectiveness of other therapies if the device is subsequently removed.

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Without adequate blood flow, erection problems can occur. In some cases, the erection is weak. In others, the man is unable to have an erection at all.
All our stem cell treatments in Mexico are reviewed and administered by subject manner specialist in the area trained in US and Mexico, not just general doctors or physicians, to ensure the highest level of precision, understanding of the condition and quality of treatment for our patients. We are 100% clear and honest with our patients, not everyone is a candidate for our stem cell treatments, we turn-down many patients where the our specialist evaluates the current health condition and medical history and deems not a good fit for the treatment, to avoid false promises or expectations when the risks outweigh the benefits. For this reason and to ensure patient safety in all our treatments, all our patients get evaluated by the specialist before being able to schedule their treatment.

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Having a healthy sex life and enjoying sexual activity is a normal, enjoyable part of living. Regular pelvic exercises can improve sexual performance by preventing premature ejaculation, help maintain an erection and even eliminate ED.

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While many men turn to the medicine cabinet in search of a solution for this painful ailment, it’s actually true that natural remedies and technologies may be just as effective at correcting ED. There’s the penis pump, a device growing in popularity, but there are also devices that are simple to operate with no known side effects.

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    Yale Medicine Urology offers many advanced medical and surgical options to address erectile dysfunction. The department is guided by personalized care to treat the patient.

    The recommended starting dose of tadalafil for use as needed for most patients is 10 mg taken orally approximately one hour before sexual activity. A doctor may adjust the dose higher to 20 mg or lower to 5 mg depending on efficacy and side effects. Doctors recommended that patients take tadalafil no more frequently than once per day. Some patients can take tadalafil less frequently since the improvement in erectile function may last 36 hours. Patients may take tadalafil with or without food. Tadalafil is currently the only PDE5 inhibitor that is FDA-approved for daily use for erectile dysfunction and is available in 2.5 mg or 5 mg dosages for daily use.
    Charney, D. S., Heninger, G. R. & Sternberg, D. E. (1982) Assessment of alplu2adrenergic autoregulator function in humans: effects of oral yohimbine. Life Sciences, 30, 2033–2041.CrossRefGoogle Scholar

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    To be able to get the best benefits from the Kegel exercises you should allow your body a break from the exercises and it is recommended that you only do the exercises 3 to 4 days per week.

    At Yale Medicine, we take a multidisciplinary approach to determine the underlying causes of your erectile dysfunction, and we understand the relationship between erectile dysfunction and other health issues. We regularly collaborate with colleagues across different areas of medicine to help patients who we treat.
    Follow your doctor’s instructions when taking ED medicine. Usually, a man takes 1 tablet 30 minutes to 1 hour before he plans to have sex. Sildenafil works for 4-8 hours; vardenafil works for up to 8 hours; and tadalafil works for up to 36 hours.

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    ED treatments are not considered to be addictive, although they can result in psychological dependence where men with performance anxiety come to rely on them.

    While helpful for some people, these drugs may not be safe for those who take nitrate drugs, have low or high blood pressure, have severe liver disease, or have kidney disease. Not to mention, they may come with side effects including dizziness and fainting, a stuffy or runny nose, as well as blurred vision.
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    Men with ED can lose confidence in their sexual ability and their overall sense of self-worth can be negatively affected.

    Smoking, excessive use of alcohol and illicit drugs are also associated with ED.13 A study in 2005 suggests that ED is not only more likely among men who smoked compared with those who never did, but that in younger men with ED, cigarette smoking is very likely the cause of their impotence.14 15
    Ambrosi, B., Bara, R., Travaglini, P., et al (1977) Study of the effects of bromocriptine on sexual impotence. Clinical Endocrinology, 7, 417–421.CrossRefGoogle ScholarPubMed

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Prostaglandin E1 (intraurethral alprostadil or MUSE) can be inserted in a pellet (suppository) form into the urethra to attain erections. It is available in four dosage strengths: 125 mcg, 250 mcg, 500 mcg, and 1,000 mcg. Most individuals need 500 mcg to 1,000 mcg for a satisfactory response.

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Due to the fact that ED and CVD share many of the same risk factors, it is not surprising that there is a high incidence of ED in men who present with CVD. A study by Montorsi et al found that ED was present in roughly 50% of patients with acute chest pain and confirmed CAD on angiography.21

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Ishii, N., Watanabe, H., Irisawa, C., et al (1989) Intracavernous injection of prostaglandin E1 for the treatment of erectile impotence. Journal of Urology, 141, 323–325.CrossRefGoogle ScholarPubMed

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While most men will have occasional difficulty achieving a healthy erection during sexual intercourse, ED is only considered a possible medical explanation for these symptoms if erection difficulties have been affecting a man for an extended period of time. When blood flow to the two chambers of the penis, known as the corpora cavernosa, are blocked or restricted for any reason, this can result in ED.

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